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n233 final > inflammatory bowel disease > Flashcards

inflammatory bowel disease Flashcards

1
Q

what is IBD?

A

two chronic inflammatory GI disorders

  • chrons and ulcerative colitis
  • complex disease that arises because of environmental and genetic factors
  • approx 260000 canadians have IBD
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2
Q

cause of IBD?

A 
mainly known
possible causes: 
-autoimmune factors
-genetic factors
-environmental triggers (pesticides, food additives, tobacco- chrons, radiation, NORTHERN alberta??)
-bacteria d/t antibiotic use
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3
Q

chrons disease?

A

subacute/chronic inflammation anywhere in GI tract, most commonly impacts distal ileum and colon

  • discontinuous “skip lesions”, clusters of ulcers
  • transmural: therefore complications can include absecesses, fissures, fistulas, perforation
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4
Q

in advanced disease, bowel can thicken, become fibrotic, narrowed and disease loops can adhere to other loops… risk for

A

bowel obstructions (dont use metoclopramide!)

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5
Q

crohns assessment?

A
  • RLQ pain (ileum/ascending colon) that occurs with diarrhea but does not decrease with defecation
  • palpable RLQ tenderness and hyperactive bowel sounds
  • weight, nutritional status
  • steatorrhea
  • extraintestinal manifestations
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6
Q

crohns complications?

A

SBO

  • fluid and electrolyte imbalance
  • malnutrition
  • fistula and abscess formation
  • increased risk for colon cancer
  • retinitis, iritis, erythema nodosum
  • mood disorders
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7
Q

what is ulcerative colitis?

A

inflammation of mucosal and submucosal layers of rectum, advancing proximally through colon
-continuous ulceraton
-can lead to pseudopolyps—> why may cause pain and bleeding
at increased risk for toxic megacolon, perforation, colon cancer, nephrolithiasis

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8
Q

ulcerative colitis assessment?

A

LLQ pain, abd distention, assess weight and nutritional status, dehydration, electrolytes, blood in stool

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9
Q

complications of ulcerative colitis?

A 
toxic megacolon 
perforation
bleeding from ulceration 
fluid/electrolyte imbalances
malnutrition
depression 
nephrolithiasis 
malignant neoplasms
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10
Q

common presentation?

A

chronic diarrhea, abd pain, fever, arthritis, anorexia

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11
Q

IBD diagnostics?

A
  • proctosigmoidoscopy or colonoscopy with biopsy= GOLD standard
  • barium enema
  • upper GI series
  • CT scan
  • CBC, alb, K+, Na+, RFTs
  • stool culture (blood/occult blood, steatorrhea- opaque or white, fat., parasites)
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12
Q

IBD management?

A

reduce inflammation (prednisone)

  • suppress inappropriate immune response (infliximab, sulfasalazine)
  • rest bowel (parenteral nutrition)
  • correct fluid and electrolyte imbalance
  • nutritional therapy
  • prevent or minimize complications
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13
Q

surgical interventions?

A
  1. total colectomy (ileostomy)
  2. continent ileostomy (k-pouch)
  3. temporary loop ileostomy
  4. ileoanal anastomosis with J-pouch
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14
Q

pharmacology for IBD?

A
  • corticosteroids (prenisone, hydrocortisone)
  • amino salicylate formulation (sulfasalazine)
  • monoclonal antibodies (infliximab= remicade)
  • opioids
  • antiperistaltics and antidiarrheals MAY be used to rest bowel during extreme flares, supportive care NOT curative
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15
Q

corticosteroids?

A

regulate vital functions involving CV, metabolic, and immunologic functions

  • effects are diverse as well as their potential side effects
  • quickly and effectively suppress inflammatory and immune response
  • EXAMPLE: hydrocortisone and prednisone
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16
Q

common uses for steroids?

A
  • adrenocortical insufficency
  • asthma
  • COPD
  • IBD!!
  • spinal injury
  • allergic reactions
  • post-transplant rejection
  • arthritis
  • cancer
  • nausea related to chemo
17
Q

common side effects of corticosteroids (lots!!)

A
  • increased blood glucose
  • decreased immune response (increased risk of infection)
  • decreased inflammatory response
  • decreased wound healing
  • weight gain/facial swelling (moon face)
  • osteoporosis
  • increased risk of ulcers
  • increased risk of mood disorders
  • electrolyte disorders
  • steroid induced psychosis?? euphoria??
  • recommend to have PPI on board
  • CONTRAINDICATED IN PREGNANCY
  • can become addicted long-term -dehydration (fluid volume deficit)
18
Q

how to minimize side effects of corticosteroids?

A
  • short periods of time
  • large doses initially then gradually decrease
  • increased risk of side effects after continually use for 7-10 days
  • give steroids with food
  • alternate day dosing
  • locally instead of systemically given
19
Q

nursing considerations for corticosteroids?

A

-monitor for potential hyperglycemia
-give oral steroids with food if possible
-monitor for s and s of infection, skin breakdown
monitor electrolytes (increased Na, decreased K)
monitor mood/behaviour changes

20
Q

5-ainosalicylic acid???

A 
chemically similar to aspirin 
5-ASA is a metabolite of sulfasalazine 
-helps to decrease symptoms of IBD (fever, stomach pain, diarrhea, rectal bleeding)
ANTI INFLAMMATORY 
-SULFASALAZINE
21
Q

monoclonal antibodies?

A

form of immunotherapy
-mAb bind to specific target cells or proteins and possible stimulate pt immune response to attack those cells
-also used in cancer therapy
INFIXIMAB (remicade)
-effective treatment for IBD synchronized with steroids or sulfasalazine

22
Q

75% of patients with chrons..

A

undergo surgery within 10 years

23
Q

major issue associated with pharm treatment of IBD?

A

noncompliance :( uncle kenny i love uuuuu

greater chance of disease relapse

24
Q

nutrition for IBD?

A

oral fluids, low residue, high protein, high calorie, supp vitamins, any foods that trigger diarrhea AVOID
-avoid smoking and cold food (increase intestinal motility)
MAY need TPN

25
Q

what is toxic megacolon?

A

inflammation extends to muscularis, inabillity to contract, colonic distension (fever, pain, distension, vomiting, fatigue….) ifnot responding to treatment, surgery (total colectomy)

26
Q

physiological responses can glucocorticoids?

A

at low doses, higher doses more intense

n233 final (11 decks)

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